Decolonization vs Enhanced Cleaning for Multidrug-Resistant Organism Reduction in Nursing Homes

Area of Science:

• Infection Control and Prevention
• Healthcare Epidemiology
• Antimicrobial Resistance

Background:

• Multidrug-resistant organisms (MDROs) pose a significant threat in healthcare settings.
• Universal decolonization and enhanced cleaning are strategies to mitigate MDRO transmission.
• The independent and combined effects of these strategies on MDRO burden are not fully understood.

Purpose of the Study:

• To evaluate the independent and combined associations of universal decolonization and enhanced cleaning with MDRO carriage.
• To assess the impact of these interventions on environmental contamination with MDROs.

Main Methods:

• A 4-phase quality improvement study was conducted in two nursing homes.
• Interventions included universal decolonization (chlorhexidine bathing, nasal iodophor), enhanced cleaning, or both, compared to routine care.
• Serial point-prevalence assessments of MDRO carriage and environmental contamination were performed.

Main Results:

• Universal decolonization alone significantly reduced MDRO carriage (AOR, 0.41) and bedroom contamination (AOR, 0.16).
• Enhanced cleaning alone did not significantly reduce carriage or bedroom contamination.
• Both interventions reduced common area contamination, with the combination showing the greatest effect (AOR, 0.30 for decolonization alone vs. combined).

Conclusions:

• Universal decolonization is effective in reducing MDRO carriage and bedroom contamination.
• Enhanced cleaning may offer additional benefits for reducing common area contamination when combined with decolonization.
• These findings inform strategies for controlling MDRO transmission in long-term care facilities.